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Microorganisms Nov 2021Deep neck infections (DNIs) such as parotid abscesses are medical emergencies with a seemingly different etiology and treatment course from other DNIs. We sought to...
Deep neck infections (DNIs) such as parotid abscesses are medical emergencies with a seemingly different etiology and treatment course from other DNIs. We sought to confirm this in the present retrospective population-based cohort study. Between August 2016 and January 2020, 412 patients with DNIs seen at a tertiary medical center were enrolled in this study. Infections of the parotid space were compared with those of other deep neck spaces, according to patient characteristics. All patients were divided into parotid space (PS; = 91, 22.08%) and non-parotid space (NPS; = 321, 77.92%) subgroups. We further divided the patients into single parotid space (PS-single; = 50, 12.13%), single non-parotid space (NPS-single; = 149, 36.16%), multiple parotid space (PS-multiple; = 41, 9.95%), and multiple non-parotid space (NPS-multiple; = 172, 41.76%) DNI subgroups. In the PS-single and PS-multiple subgroups, a longer duration of symptoms ( = 0.001), lower white blood cell count ( = 0.001), lower C-reactive protein level ( = 0.010), higher rate of ultrasonography-guided drainage ( < 0.001), and lower rates of surgical incision and drainage ( < 0.001) were observed compared with the NPS-single and NPS-multiple subgroups. The PS group had a higher positive culture rate ( < 0.001), and lower positive ( = 0.002), and ( = 0.025) culture rates than the NPS group. In a multivariate analysis, was independently associated with parotoid space involvement in comparisons of the PS and NPS groups, PS-single and NPS-single subgroups, and PS-multiple and NPS-multiple subgroups. The clinical presentation of a parotid space infection differs from that of other deep neck space infections.
PubMed: 34835486
DOI: 10.3390/microorganisms9112361 -
Revista Espanola de Quimioterapia :... Feb 2022
Topics: Humans; Tuberculosis, Spinal
PubMed: 34812032
DOI: 10.37201/req/098.2021 -
Medicine Nov 2021Empyema caused by Streptococcus constellatus is rare in patients without underlying diseases. However, the importance of the Streptococcus anginosus group, which...
RATIONALE
Empyema caused by Streptococcus constellatus is rare in patients without underlying diseases. However, the importance of the Streptococcus anginosus group, which consists of S constellatus, S anginosus, and Streptococcus intermedius, as causative organisms of empyema has been increasing.
PATIENT CONCERNS
A 78-year-old man initially presented with dyspnea and chills for 4 days. He had no medical history.
DIAGNOSIS
Chest X-ray and chest computed tomography showed a large and multiloculated pleural effusion with an air bubble on the right side. Cultivation of the pleural effusion using clone library analysis of the 16S rRNA gene revealed S constellatus positivity.
INTERVENTIONS
The patient was treated by drainage of the pleural effusion and intravenous ceftriaxone and clindamycin for the possibility of anaerobes, followed by 10 weeks of oral antibiotics.
OUTCOMES
On the 11th day of admission, the thoracic drainage tube was removed. After 1 year of treatment, there were no sequelae of empyema.
LESSONS
Although S constellatus can cause serious infections in patients with underlying diseases and immunosuppression, physicians need to consider S constellatus infection in community-acquired empyema in elderly individuals. It should be treated with early pleural drainage and antibiotics to avoid surgical decortication and prolonged hospitalization.
Topics: Aged; Anti-Bacterial Agents; Empyema, Pleural; Humans; Male; Pleural Effusion; RNA, Ribosomal, 16S; Streptococcal Infections; Streptococcus constellatus
PubMed: 34766602
DOI: 10.1097/MD.0000000000027893 -
Cureus Sep 2021Pyogenic liver abscesses (PLAs) are a rare condition in North America and Europe and, rarer still, the cause of septic shock. This case report will describe the rare...
Pyogenic liver abscesses (PLAs) are a rare condition in North America and Europe and, rarer still, the cause of septic shock. This case report will describe the rare occurrence of a PLA producing septic shock in a 36-year-old male residing in the United Kingdom following a case of complicated appendicitis. The patient presented to the emergency department (ED) with a three-week history of intermittent loose stools, cramping abdominal pain, recurrent fevers, a heart rate of 111 beats per minute, a blood pressure of 94/58 mmHg, and a fever of 40.1 degrees Celsius. Despite prompt broad spectrum antibiotic administration and three liters of fluid resuscitation, the patient remained shocked which led to an ICU admission. A CT scan prior to transfer found a 7 cm x 6 cm x 6 cm lesion representing a liver abscess (LA) as well as gross inflammatory change affecting the distal small bowel. The LA was managed through insertion of a percutaneous drain under ultrasound guidance performed by the interventional radiology team, as well as ongoing IV antibiotics. Following growth of the gut commensal from the abscess fluid culture, a colonoscopy was performed which found a severely distorted and inflamed terminal ileum with an impassable stricture, raising not only the suspicion of appendicitis but also Crohn's disease. Following the colonoscopy, after a total of 10 days admission, the patient was allowed to go home with a four-week course of oral co-amoxiclav. After discharge, the patient's case was discussed in the gastroenterology inflammatory bowel disease (IBD) multi-disciplinary team meeting due to concerns raised about possible Crohn's disease from the admission CT and following colonoscopy findings. Given the absence of relevant IBD symptoms, a reassuring outpatient MRI small bowel scan (found considerable resolution of the right iliac fossa inflammatory process) and a fecal calprotectin of 29 four months post discharge (normal=0-51 μg/g), it was concluded the terminal ileum changes were most likely accounted for by a complicated course of appendicitis. When reviewed in a telephone clinic 10 weeks post discharge, he was found to have no persistent gastrointestinal (GI) symptoms and was subsequently discharged. This case highlights the importance of comprehensive imaging and colonoscopy in the work up of those patients with PLAs with no otherwise evident precipitating factor.
PubMed: 34725610
DOI: 10.7759/cureus.18359 -
Journal of Clinical Microbiology Jan 2022The performance of the Liofilchem omadacycline MIC Test Strip (MTS) was evaluated in a multisite study. Three testing sites collected/tested clinical isolates and one...
The performance of the Liofilchem omadacycline MIC Test Strip (MTS) was evaluated in a multisite study. Three testing sites collected/tested clinical isolates and one site tested challenge isolates that totaled 175 S. aureus, 70 , 121 E. faecalis, 100 E. faecium, 578 Enterobacterales, 142 Haemophilus spp., 181 S. pneumoniae, 45 group, 35 S. pyogenes,and 20 S. agalactiae. MIC testing was performed by CLSI broth microdilution (BMD) and MTS. Fastidious isolates testing included BMD and MTS testing with both CLSI and EUCAST Mueller-Hinton Fastidious (MH-F). In addition, each site performed reproducibility for nonfastidious and fastidious isolates and QC by MTS and BMD. All BMD and MTS results for the QC strains were within expected ranges, with exception of one MTS HTM result for H. influenzae ATCC 49247. Among reproducibility isolates, omadacycline MTS results were within one dilution of the modal MIC for 95.2% of nonfastidious Gram-positive, 100% of Gram-negative, 99.3% and 98.5% of fastidious isolates tested on CLSI and EUCAST media, respectively. MTS results for all study isolates were within one doubling dilution of the CLSI BMD MIC for 98.9% of S. aureus, 100% of , 98.3% of E. faecalis, 100% of E. faecium, and 99.6% of Enterobacterales. Essential agreement rates for CLSI and EUCAST MH-F agar compared to CLSI BMD were 98.2% and 98.2%, for H. influenzae, 91.1% and 73.6%, for S. pneumoniae and 100% and 85-91.7% for other streptococcus species, respectively. Based on CLSI media, all categorical errors were minor errors and categorical agreement rates were >90% with exception of C. freundii, E. faecalis, and S. constellatus.
Topics: Anti-Bacterial Agents; Bacteria; Gram-Negative Bacteria; Humans; Microbial Sensitivity Tests; Reproducibility of Results; Staphylococcus aureus; Tetracyclines
PubMed: 34613800
DOI: 10.1128/JCM.01410-21 -
Case Reports in Women's Health Oct 2021A 57-year-old patient presented with vaginal discharge and was found to have a pelvic abscess with and , with likely nidus of infection being a non-absorbable suture...
A 57-year-old patient presented with vaginal discharge and was found to have a pelvic abscess with and , with likely nidus of infection being a non-absorbable suture placed during colporrhaphy three years prior. She was treated with drain placement and antibiotics. Post-hospitalization, her colporrhaphy suture was removed. Subsequently the drain output decreased and this was removed as well. She had a total course of 6 weeks of amoxicillin/clavulanate, with complete resolution of her abscess.
PubMed: 34611518
DOI: 10.1016/j.crwh.2021.e00359 -
BMJ Case Reports Oct 2021We present the case of a 61-year-old woman who presented to the accident and emergency department with an ischaemic stroke, on a background of receiving intravenous and...
We present the case of a 61-year-old woman who presented to the accident and emergency department with an ischaemic stroke, on a background of receiving intravenous and oral antibiotics to treat chronic left sphenoid sinusitis. Initially presenting with right-sided weakness and aphasia, a diagnosis of acute ischaemic stroke was made. Antibiotics had been commenced 1 month prior to the ischaemic stroke. Imaging at that time showed changes in keeping with chronic sphenoid sinusitis along with a small dehiscence in the lateral wall of the left sphenoid sinus and thrombosis of the left superior ophthalmic vein. During that admission blood cultures grew , a member of the Streptococcus milleri group. We discuss the unusual aetiology of this stroke, the emerging evidence associating chronic rhinosinusitis with stroke and the complex multidisciplinary approach required for management in this case.
Topics: Brain Ischemia; Female; Humans; Ischemic Stroke; Middle Aged; Sphenoid Sinusitis; Stroke; Tomography, X-Ray Computed
PubMed: 34607813
DOI: 10.1136/bcr-2021-242943 -
Diagnostics (Basel, Switzerland) Aug 2021Deep neck infection (DNI) is a serious disease that can lead to airway obstruction, and some patients require a tracheostomy to protect the airway instead of intubation....
Deep neck infection (DNI) is a serious disease that can lead to airway obstruction, and some patients require a tracheostomy to protect the airway instead of intubation. However, no previous study has explored risk factors associated with the need for a tracheostomy in patients with DNI. This article investigates the risk factors for the need for tracheostomy in patients with DNI. Between September 2016 and February 2020, 403 subjects with DNI were enrolled. Clinical findings and critical deep neck spaces associated with a need for tracheostomy in patients with DNI were assessed. In univariate and multivariate analysis, older age (≥65 years old) (OR = 2.450, 95% CI: 1.163-5.161, = 0.018), multiple spaces involved (≥3 spaces) (OR = 4.490, 95% CI: 2.153-9.360, = 0.001), and the presence of mediastinitis (OR = 14.800, 95% CI: 5.097-42.972, < 0.001) were independent risk factors associated with tracheostomy in patients with DNI. Among the 44 patients with DNI that required tracheostomy, ≥50% of patients had involvement of the parapharyngeal or retropharyngeal space (72.72% and 50.00%, respectively). (25.00%) was the most common pathogen in patients with DNI who required tracheostomy. In conclusion, requiring a tracheostomy was associated with a severe clinical presentation of DNI. Older age (≥65 years old), multiple spaces (≥3 spaces), and presence of mediastinitis were significant risk factors associated with tracheostomy in patients with DNI. The parapharyngeal and retropharyngeal spaces were the most commonly involved, and was the most common pathogen in the patients with DNI that required tracheostomy.
PubMed: 34573878
DOI: 10.3390/diagnostics11091536 -
BMC Infectious Diseases Sep 2021Actinomyces odontolyticus is not commonly recognized as a causative microbe of liver abscess. The detection and identification of A. odontolyticus in laboratories and...
BACKGROUND
Actinomyces odontolyticus is not commonly recognized as a causative microbe of liver abscess. The detection and identification of A. odontolyticus in laboratories and its recognition as a pathogen in clinical settings can be challenging. However, in the past decades, knowledge on the clinical relevance of A. odontolyticus is gradually increasing. A. odontolyticus is the dominant oropharyngeal flora observed during infancy [Li et al. in Biomed Res Int 2018:3820215, 2018]. Herein we report a case of severe infection caused by A. odontolyticus in an immunocompromised patient with disruption of the gastrointestinal (GI) mucosa.
CASE PRESENTATION
We present a unique case of a patient with human immunodeficiency virus infection who was admitted due to liver abscess and was subsequently diagnosed as having coinfection of A. odontolyticus, Streptococcus constellatus, and Candida albicans during the hospital course. The empirical antibiotics metronidazole and ceftriaxone were replaced with the intravenous administration of fluconazole and ampicillin. However, the patient's condition deteriorated, and he died 3 weeks later.
CONCLUSION
This report is one of the first to highlight GI tract perforation and its clinical relevance with A. odontolyticus infection. A. odontolyticus infection should be diagnosed early in high-risk patients, and increased attention should be paid to commensal flora infection in immunocompromised individuals.
Topics: Actinomyces; Ampicillin; Ceftriaxone; HIV Infections; Humans; Liver Abscess; Male
PubMed: 34556028
DOI: 10.1186/s12879-021-06703-6 -
Cureus Aug 2021A 35-year-old obese female patient presented to the emergency department (ED) endorsing symptoms of generalized weakness, dyspnea, and myalgia. Vitals on admission...
A 35-year-old obese female patient presented to the emergency department (ED) endorsing symptoms of generalized weakness, dyspnea, and myalgia. Vitals on admission revealed hypotension, tachycardia, and a low-grade fever. Physical examination was unremarkable and was negative for any upper right quadrant tenderness or jaundice. Laboratory results revealed an elevated leukocytosis with a predominantly elevated neutrophil count, an elevated lactate dehydrogenase, aminotransferases, and an elevated anion gap. Sepsis protocol was initiated. Blood cultures revealed Group F Streptococcus. A chest x-ray for localization of the primary infection source was significant for an incidental hypodense liver mass. A follow-up magnetic resonance imaging (MRI) without contrast revealed a left hepatic multiloculated enhancing lesion prompting the diagnosis of beta-hemolytic Group F Streptococcus pyogenic hepatic abscess (PHA). This unusual case seeks to inform that an obese patient (i.e., immunocompromised) with systemic signs (e.g., fever, hypotension, tachycardia) should warrant careful monitoring as well as the inclusion of pyogenic liver abscess in the differential workup as our patient's PHA was found incidentally on a chest x-ray. Appropriate management via sonographic guided drainage was initiated and systemic antibiotics were administered in both inpatient and outpatient settings, resulting in complete resolution of the hepatic abscess over the course of a month.
PubMed: 34513532
DOI: 10.7759/cureus.17626